POLICY: Not Seen, Not Heard – identifying children at risk

Health services need to do more for children at risk of harm, according to the health and social care inspectorate, the Care Quality Commission (CQC). The CQC has called on healthcare leaders and staff to do more to identify and listen to children at risk of harm, in its new report Not Seen, Not Heard.

Not Seen, Not Heard looks at how effective health services are in providing early help to children in need, the health and wellbeing of looked-after children and how these services identify and protect children at risk of harm.

The report serves as a reminder that all children and young people have the right to be protected from abuse and exploitation. They also have the right to have their health and welfare safeguarded.

The CQC says that, although local authorities have overarching responsibility for safeguarding, every organisation and person who comes into contact with a child has a role to play. It explains that healthcare professionals are in strong position to address children’s health and welfare needs and safeguarding concerns.

The report concludes that health professionals have improved the way they assess risk and recognise safeguarding concerns, but that services are not consistently protecting and promoting the health and welfare of children. It urges a whole system response to do more to listen to and involve children in need in their care.

More must be done by health providers, including staff in hospitals, health visitors and GPs, as well as commissioners, to ensure that services are improving outcomes for children, strengthening the quality of information sharing and joint-working, the report says.

Not Seen, Not Heard contains many best practice examples of effective service delivery and CQC is appealing to health professionals and leaders to use it as a learning tool.

Themes in the report include:

Involvement: Too often the voice of the child had been lost. The views and experiences of children and young people are gathered on every inspection and in the review, 62% said that their voice was not heard or they did not feel involved in their care. Listening to children is paramount to child protection. The extent that children feel listened to, significantly influences how safe and happy they feel. All healthcare providers should also engage children in their care planning to help them to be involved in and take ownership of their treatment and care.

Identification: The risks to children are not always obvious and require a continuous professional curiosity about the child and their circumstances. The emphasis should be on preventative work with those in need of early help (such as children with parents with substance misuse issues) as well as those at risk of hidden harms. Staff working in adult health services, including mental health, should be routinely assessing any risks to children who may be at home. Staff across services should be better supported to identify, protect and support children at risk of other harms, such as sexual exploitation and FGM.

Mental Health: Access to mental health support for children must be addressed as a priority. Currently, children’s experiences in transition to adult services are unacceptably poor and must improve, especially for those leaving paediatric care, going into adult mental health and substance misuse services. Children in residential care are seven times more likely to have a mental health issue compared to the rest of the population (72% compared to 10%). They frequently do not have access to the care they need, particularly when they move area and when they leave care. Local authorities are not using screening tools to assess wellbeing in line with national guidance. Of 38 inspections that commented on the quality of these tools, just five were used effectively to inform health reviews (13%).

Referrals: While health professionals have improved how they assess risk and recognise safeguarding concerns, CQC has identified problems with the way these risks are shared with other services (for example, a GP, nurse or doctor to a social worker). Practitioners frequently did not articulate the risks to the child to set out what they expected from the referral, leaving the receiving team unclear of the concerns (a referral is made by health professionals to child protection/social workers when they are concerned a child is at risk of harm or abuse). In A&E departments in the 50 areas inspected, 16 were criticised for not making effective referrals(32%).

Information sharing: Children experience more coordinated, joined-up and efficient care where there are arrangements for how to share information, make referrals and provide support. CQC identified the features of safe joint-working and information sharing and also endorsed the national implementation of the Health and Social Care Information Centre’s Child Protection Information Sharing Project. This is designed to improve the level of protection given to children who present unscheduled in NHS settings, such as GPs, hospitals, and minor injury units. All NHS organisations are required to implement this system by 2018.

The CQC has published key points from the review specifically for children and young people, as well as an animation that highlights some of the key findings and recommendations, and the full report. All these are available at www.cqc.org.uk/NotSeenNotHeard

For more updates follow the hashtag: #NotSeenNotHeard on Twitter and let us know what you think of the role health professional play in safeguarding @weareMFON

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